Prevalence, Characteristics and Outcomes of Ventilator-Associated-Conditions
CCCF ePoster library. Makar A. Oct 28, 2015; 117356; P118
Mr. Ameir Makar
Mr. Ameir Makar
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Abstract
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P118


Topic: Retrospective or Prospective Cohort Study


Prevalence, Characteristics and Outcomes of Ventilator-Associated-Conditions



Ameir Makar, J. Muscedere

Queen's School of Medicine, Queen's University, Kingston, Ontario, Canada | Critical Care Medicine, Queen's University, Kingston Ontario, Canada

Introduction: Patients who are mechanically ventilated are at an increased risk for developing multiple respiratory complications. Ventilator-Associated-Conditions (VAC) collectively describes any condition that results in an increase in respiratory support following a previous state of respiratory stability during mechanical ventilation. These conditions can be further sub-classified into Infectious-Ventilator-Associated-Conditions (iVAC) and Ventilator-Associated-Pneumonia (VAP). As VAC represents a novel surveillance paradigm in the monitoring of ventilator complications, little is known about its prevalence and prevention, and further evidence is needed in order to characterize the outcomes of this condition and assess the impact it has on patient's ICU course.

Objectives: To determine the prevalence of VAC, iVAC and VAP among mechanically ventilated ICU patients, and to compare the patient characteristics and hospital outcomes between those who develop VAC and those who do not.

Methods: This was a retrospective chart review conducted at the 33 bed, Level-3 ICU in Kingston General Hospital. Patients >16 years of age, who were mechanically ventilated for >48 hours between January 2015 and May 2015 were retrospectively assessed for the development of VAC, iVAC and VAP. Descriptive statistics were used to describe the prevalence and characteristics of VAC, iVAC and VAP. Patient characteristics and outcome data between those with VAC and those without VAC were compared using independent t-tests for continuous data and chi-square tests for categorical data. Statistical analysis was completed using IBM SPSS 17.

Results: A total of 154 patients, comprising 1318 ventilator days, were included in this study. Among these patients, 34 (22.1%) developed a VAC, 10 (6.5%) developed an iVAC, and 5 (4.5%) developed a VAP. The mean number of days to VAC onset was 4.7 ventilator days. Compared to those who did not develop a VAC, those with a VAC were associated with a longer ICU duration (15.7 days vs 11.8 days, p=0.0018), increased length of mechanical ventilation (11.1 days vs 7.9 days, p=0.005), a greater number of antibiotic days during ventilation (8.5 days vs 5.7 days, p=0.009) and a higher occurrence of tracheostomy tube insertion (17.6% vs 3.3%, p=0.008). Among the patient characteristics measured, VAC was seen to correlate with hospital admission type, though was not associated with the cause of intubation, type of endotracheal tube, site of intubation, or admission APACHE-II score.

Conclusion: VAC is a serious, yet common complication in the ICU, occurring in around one in five patients mechanically ventilated greater than 48 hours. Those who developed a VAC were observed to experience a longer ICU admission and required additional ventilatory support. Further studies are needed in order to identify possible modifiable factors in reducing the rate of VAC and aim to mitigate the downstream complications seen in this already vulnerable patient population.

References:

1. Bouadma L, Sonneville R, Garrouste-Orgeas M, Darmon M, Souweine B, Voiriot G, et al. Ventilator-Associated Events: Prevalence, Outcome, and Relationship With Ventilator-Associated Pneumonia. Crit Care Med. 2015 May 14; 43(9):1798-806.

2. Klompas M, Kleinman K, Murphy M V. Descriptive epidemiology and attributable morbidity of ventilator-associated events. Infect Control Hosp Epidemiol. 2014 May; 35(5):502–10.

3. Klompas M, Richard B, Eichenwald EC, Greene LR, Howell MD, Lee G, et al. Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals: 2014 Update. Infect Control Hosp Epidemiol. 2014 Jan; 35(8):915–36.

4. Lewis SC, Li L, Murphy M V, Klompas M. Risk factors for ventilator-associated events: a case-control multivariable analysis. Crit Care Med. 2014 Aug; 42(8):1839–48.

5. Muscedere J, Sinuff T, Heyland DK, Dodek PM, Keenan SP, Wood G, et al. The clinical impact and preventability of ventilator-associated conditions in critically ill patients who are mechanically ventilated. Chest. 2013 Nov; 144(5):1453–60.

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